# Improving oxygenation in a patient with respiratory failure due to morbid obesity by applying airway pressure release ventilation: a case report

## TL;DR

A morbidly obese patient with severe breathing difficulties showed significant improvement in oxygen levels after switching to a specific ventilation method called airway pressure release ventilation.

## Contribution

This case report demonstrates airway pressure release ventilation as a potential early therapeutic option for respiratory failure in morbidly obese patients.

## Key findings

- Switching to airway pressure release ventilation improved the patient's PaO2/FIO2 ratio from ~100 to ~300.
- The patient was successfully weaned off the ventilator after 29 days.
- Reduced sedative use and enabled respiratory rehabilitation following ventilation change.

## Abstract

Morbidly obese patients occasionally have respiratory problems owing to hypoventilation. Airway pressure release ventilation is one of the ventilation settings often used for respiratory management of acute respiratory distress syndrome. However, previous reports indicating that airway pressure release ventilation may become a therapeutic measure as ventilator management in morbid obesity with respiratory failure is limited. We report a case of markedly improved oxygenation in a morbidly obese patient after airway pressure release ventilation application.

A 50s-year-old Asian man (body mass index 41 kg/m2) presented with breathing difficulties. The patient had respiratory failure with a PaO2/FIO2 ratio of approximately 100 and severe atelectasis in the left lung, and ventilator management was initiated. Although the patient was managed on a conventional ventilate mode, oxygenation did not improve. On day 11, we changed the ventilation setting to airway pressure release ventilation, which showed marked improvement in oxygenation with a PaO2/FIO2 ratio of approximately 300. We could reduce sedative medication and apply respiratory rehabilitation. The patient was weaned from the ventilator on day 29 and transferred to another hospital for further rehabilitation on day 31.

Airway pressure release ventilation ventilator management in morbidly obese patients may contribute to improving oxygenation and become one of the direct therapeutic measures in the early stage of critical care.